I received an e-mail at firstname.lastname@example.org from a C. Biswas in another country asking for advice on a dental problem their child was having. The problem was that the milk tooth (baby tooth) had been lost and the permanent front tooth (central incisor) had replaced it, but the tooth had become loose. The child’s parent wanted advice on what to do to prevent the loss of the permanent tooth. They wanted to know also if the tooth would be replaced by another tooth growing in. I told them that there would be no replacement tooth to replace the permanent tooth if it was lost. I sent an e-mail to them, but thought it might be a topic that other people might have an interest in. Permanent teeth do not have complete root formation when the tooth erupts, but the root continues to develop over time after eruption of the tooth. This makes them less stable in the bone.
There are 3 main causes a permanent tooth to become loose in children. They are: 1) an injury that affects that specific tooth; 2) some form of periodontal disorder that destroys the supportive bone around the tooth; and 3) a traumatic occlusion (bite) that causes one tooth to hit before all the other teeth when biting down.
Most traumatic injuries to teeth are from a blow to the face, or a fall that involves the mouth hitting something. In most cases the best treatment is to splint, or to attach it to the adjacent teeth by bonding a wire to the teeth with a tooth colored filling material. If no adjacent teeth are available on both sides of the affected tooth, then some type of removable retainer should be used to stabilize the tooth.
I have only seen periodontal disease in 3 children in 25 years of practice. One was a congenital defect in the gum tissue itself. This case required corrective surgery to resolve the problem The other two were in children with so much plaque and tartar build up on their teeth that the tooth itself could barely be seen. This required removal of the plaque and tartar. The periodontal problems were still minor and so oral hygiene instructions were given and we are monitoring there periodontal health during their 6 month check ups.
The 3rd cause is traumatic occlusion, or bite is the easiest to fix. After evaluation of the child’s bite, the bite is adjusted by selective contouring the enamel to even out the bite so that all teeth are hitting at the same time. Usually no splint or stabilization is necessary with this type of mobility or that caused by periodontal problems.